Mechanism-Informed Dermatology: Translational Advances in Immune-Mediated Inflammatory Skin Diseases

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Abstract
Immunologic and inflammatory skin disorders have undergone a profound conceptual transformation over the past two decades. Conditions such as psoriasis, atopic dermatitis, autoimmune blistering diseases, and cutaneous lupus erythematosus are now understood as immune-mediated entities driven by specific pathogenic pathways rather than solely morphologic diagnoses. This review synthesizes contemporary high-impact literature to analyze emerging diagnostic and therapeutic paradigms, emphasizing the transition from broad immunosuppression to mechanism-informed precision targeting. Particular attention is given to the IL-23/Th17 axis in psoriasis, type 2 inflammation in atopic dermatitis, and autoantibody-mediated mechanisms in blistering disorders. The review further compares cytokine-specific biologics with intracellular pathway modulators such as JAK inhibitors, highlighting distinctions in monitoring requirements, breadth of immunologic impact, and practical considerations. A structured therapeutic sequencing model is proposed, integrating clinical severity, immunologic alignment, safety monitoring, and healthcare feasibility. Special consideration is given to implementation in diverse international contexts, including Mexico, Colombia, and Ecuador. The findings support a unified framework in which diagnosis remains clinically grounded but conceptually reinforced by immunopathogenesis, and treatment selection is increasingly guided by targeted immune modulation. This paradigm reflects the broader evolution of translational medicine and underscores the necessity of adaptable, evidence-based strategies in inflammatory dermatology.